If your loved one is recovering from active addiction, you may already know about withdrawal, a challenging stage that occurs when the body and central nervous system are adjusting to the absence of addictive substances like drugs or alcohol. What many people don’t realize, however, is that withdrawal isn’t always confined to the initial days or weeks after quitting.
There’s a second phase called post-acute withdrawal syndrome (PAWS) that can emerge long after the acute symptoms have subsided. Understanding PAWS is crucial for supporting long-term recovery, as it presents unique challenges that can affect a person’s emotional and mental well-being for months or even years.
What Is PAWS?
Post-acute withdrawal syndrome refers to a set of symptoms that persist after the acute withdrawal phase ends. While the acute withdrawal stage is the body’s immediate reaction to the absence of a substance, PAWS manifests more subtly, with psychological and emotional symptoms that can last for an extended period.1
PAWS often occurs in waves, with periods of relief followed by recurrence of symptoms, making it a frustrating and exhausting experience for the recovering individual.
PAWS can affect people recovering from addiction to various substances, including alcohol, opioids, benzodiazepines, and stimulants. It’s important to note that the severity and duration of PAWS symptoms can vary depending on the substance involved, the length of addiction, and the individual’s unique physiology.
General Symptoms of PAWS
The symptoms of PAWS are mostly psychological and emotional, although some people report mild physical effects. Common symptoms include:1
- Many individuals experience intense anxiety during PAWS, often without an obvious trigger. Panic attacks may occur, making it difficult to manage daily tasks.
- Depression is one of the main symptoms of PAWS. Those affected may feel hopeless, unmotivated, and have difficulty enjoying life, even months into their recovery.
- Many individuals in recovery report a drop in sexual desire. Low libido can strain relationships and cause additional emotional distress, as it may feel like a loss of intimacy.
- Trouble concentrating, memory lapses, and difficulty solving problems are common cognitive difficulties that can hinder work, school, and relationships.
- Persistent fatigue and insomnia are common in PAWS, which can further complicate emotional recovery.
- While physical cravings for drugs or alcohol often lessen after acute withdrawal, mental and emotional cravings can persist, making it harder to maintain sobriety.
These symptoms can last anywhere from a few months to two years, with the intensity of the symptoms gradually decreasing over time.
PAWS vs. Acute Withdrawal
The difference between acute withdrawal and PAWS lies in the timing and nature of the symptoms. Acute withdrawal symptoms occur shortly after someone stops using a substance and tend to be more physical in nature. This phase usually lasts for a few days to a few weeks, depending on the substance and the person’s usage history.1
On the other hand, PAWS primarily affects emotional and mental well-being. Rather than the intense physical symptoms seen in acute withdrawal, PAWS is characterized by long-lasting, more subtle psychological withdrawal symptoms. Importantly, PAWS symptoms tend to come and go in cycles, which can be confusing and frustrating for both the person in recovery and their loved ones.
Why Understanding PAWS Is Important
Understanding PAWS is vital for several reasons. First, it helps set realistic expectations for recovery. Loved ones may think that once the acute withdrawal phase is over, the hardest part is behind them, but PAWS can make the recovery process more complicated than expected.
Second, recognizing PAWS symptoms can help you offer more appropriate support. Someone dealing with PAWS may feel like they are “failing” at recovery when, in reality, they are going through a normal part of the process. Knowing that PAWS is common and that the symptoms can eventually subside can provide hope and reassurance.
Finally, understanding PAWS can help prevent relapse. The mental and emotional toll of PAWS can make it easier for someone in recovery to rationalize using substances again as a way to alleviate their distress. By understanding the syndrome and offering support, you can help your loved one navigate these difficult moments.
6 Coping Strategies for PAWS
While PAWS can feel overwhelming, there are effective strategies for managing the symptoms. These strategies can help your loved one regain control and maintain their sobriety during this challenging period.
1. Support Groups
Participating in support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or other addiction recovery programs can provide a valuable network of people who understand what your loved one is going through. Sharing experiences and receiving advice from others who have gone through PAWS can be comforting and reassuring.
2. Therapy
Engaging in talk therapy, particularly cognitive behavioral therapy (CBT), can help individuals learn to manage negative thoughts and emotions, reducing the intensity of PAWS symptoms. A therapist can also provide tools for dealing with mood swings, anxiety, and depression.
3. Healthy Lifestyle Choices
Encouraging a balanced diet, regular exercise, and good sleep hygiene can improve physical and mental well-being. Exercise, in particular, has been shown to reduce symptoms of anxiety and depression, both of which are common in PAWS.
4. Relaxation and Mindfulness Techniques
Doing meditation, breathing exercises, and yoga can reduce stress and promote emotional stability. These techniques are excellent tools for managing moments of intense anxiety or cravings.
5. Avoiding Triggers
Identifying and avoiding triggers is crucial in preventing a relapse during PAWS. Triggers might include specific people, places, or stressful situations. Help your loved one develop a plan for navigating situations where they might be tempted to use substances again.
6. Patience and Self-Compassion
Recovery is a long and difficult journey. Encourage your loved one to be patient with themselves and to practice self-compassion. It’s normal for recovery to have ups and downs, and setbacks should not be seen as failures.
Overcome the Challenges of PAWS With Lumina Recovery
Post-acute withdrawal syndrome is a significant, but often misunderstood, challenge in the recovery process. Recognizing the symptoms of PAWS and knowing how it differs from acute withdrawal can help you better support your loved one as they work toward long-term recovery.
At Lumina Recovery, our detox and medication-assisted treatment (MAT) programs are designed to help manage the physical and emotional challenges of post-acute withdrawal syndrome (PAWS), providing individuals with the medical support and care they need to stabilize during the early stages of recovery and beyond.
For compassionate support and expert guidance through every stage of recovery, contact Lumina Recovery today to learn more about our treatment programs and addiction centers.
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